[fr] La découverte fortuite ou la persistance d’une positivité faible de l’hCG est une situation qui n’est pas inhabituelle et qui nécessite une démarche clinico-biologique pour éviter de mauvaises interprétations susceptibles de conduire à des attitudes diagnostiques ou thérapeutiques inappropriées. Lorsque toute forme de grossesse est écartée, une persistance d’hCG évoque chez beaucoup la présence d’un contexte tumoral. Cependant, la positivité des tests peut également être due à diverses causes bénignes.
Deux cas sont décrits. Une première patiente a présenté des concentrations d’hCG faibles pendant plusieurs années, consécutivement à une fausse-couche. Après investigation, l’hypothèse retenue est celle d’une maladie trophoblastique gestationnelle quiescente. Chez une seconde patiente atteinte d’insuffisance rénale terminale, la positivité de l’hCG a été révélée préalablement à la réalisation d’un examen radiologique. Dans ce cas, l’origine serait l’accumulation d’hCG hypophysaire secondaire à la pathologie rénale.
Ces cas illustrent l’importance d’une bonne compréhension des différentes causes d’élévation de l’hCG, qui sont revues dans cet article. [en] Unexpected finding or persistence of low human chorionic gonadotropin (hCG) levels is not a rare situation. It requires a clinico-biological approach in order to avoid misunderstandings that could lead to inappropriate diagnostic or therapeutic attitudes. Beyond pregnancy, persistent low levels of hCG may be associated with various benign and malignant conditions, i.e. quiescent gestational trophoblastic disease (QTD), raised pituitary hCG or false positive elevation caused by circulating heterophile antibodies. We report the cases of two non-pregnant patients with low serum hCG. In the first case, hCG levels raised during several years following a spontaneous abortion. The likelihood of heterophilic antibodies interference was ruled out and extensive clinical investigation excluded the presence of a tumour. The diagnosis was QTD. In the second case, elevated hCG came to light as an incidental finding in a women with chronic renal failure and led the clinicians to question the laboratory. The cause was probably an increase in pituitary hCG consecutive to terminal renal failure. These cases illustrate the importance of understanding the biology of the hCG and the causes of its persistent low elevation, which are reviewed in this article. It is essential to demonstrate clinically the presence of a tumour in order to avoid unnecessary and ineffective chemotherapy and/or hysterectomy.
Disciplines :
Reproductive medicine (gynecology, andrology, obstetrics)
Author, co-author :
DE BACKER, Benjamin ; Centre Hospitalier Régionale de la Citadelle (Liège) - CHR CITADELLE > Biologie Clinique
GOFFIN, Frédéric ; Centre Hospitalier Universitaire de Liège - CHU > Gynécologie-Obstétrique CHR
NISOLLE, Michelle ; Centre Hospitalier Universitaire de Liège - CHU > Gynécologie-Obstétrique CHR
Minon, Jean-Marc; Centre Hospitalier Régionale de la Citadelle (Liège) - CHR CITADELLE > Biologie Clinique
Language :
French
Title :
Elévation faible d’hCG en dehors d’un contexte gravidique : à propos de deux cas et revue de la littérature
Alternative titles :
[en] Persistent low hCG levels beyond pregnancy: report of two cases and review of the literature
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